The Health of Our Patients Demands a Clean Fuel Standard

by Dr. Alexandra Perkins and Dr. Allie Obremskey, Seattle Children’s Hospital

A young boy is admitted to my hospital service for his third asthma exacerbation in a year. His mother’s frustration, concern and anxiety about his health is palpable — he has missed many days of school already this year due to wheezing, shortness of breath and chest tightness. Despite her best efforts and attention to his treatment plan, they can’t keep his asthma under control. Research has shown that children exposed to traffic-related air pollution carry a higher risk of asthma and related complications. We know that his symptoms are likely worse because the family lives next to the freeway.

Air pollution impacts are sometimes obvious to us as pediatricians; asthma is a visible example where a child’s symptoms flare when an exacerbating factor is near — a child’s lungs can suddenly seem like a canary in a coal mine, warning us of larger environmental health risks at work.

Air pollution has a significant negative impact on children’s health. It’s disproportionately harmful to children’s lungs because their bodies are still growing and developing. Around 80% of a child’s lung tissue will develop after birth.(1) Multiple studies have demonstrated that air pollution can contribute to significantly decreased lung development, and ultimately, decreased lung capacity as adults.(2) Unsurprisingly, it also is true that decreases in ambient air pollution are associated with improved lung function in children and easier overall breathing.

Beyond respiratory health, air pollution also increases the risk of preterm birth.(3) This is especially true for African American mothers.(4) Respiratory problems like asthma and chronic lung disease are among the myriad health consequences of premature birth that also include developmental delays, behavioral problems, cerebral palsy, and vision and hearing loss.(5)

The inequitable impacts of localized air pollution also cannot go unaddressed. A 2018 study confirmed that racial and ethnic minorities in the U.S. are exposed to 35% more PM2.5, and Black Americans, in particular, are exposed to 54% more PM2.5 than the average individual in the overall U.S. population.(6) Part of this is explained by the fact that much of our urban growth is prioritized around existing or developing transportation hubs. Further, proximity to transportation corridors is often a priority for affordable housing development. The intention, of course, is a good one — everyone deserves access to affordable and accessible transportation options to get where they need to go. But because our transportation infrastructure is reliant on dirty fuels, and this sector is currently the largest single emitter of pollution in our state, there are unintended consequences to this urban growth. What’s unacceptable is that these consequences are shouldered by already marginalized communities — exacerbating existing inequities.

For the children and teens of color who are living in these neighborhoods, air pollution is a critical risk factor for asthma and respiratory viruses. African American children with reactive airway diseases are four times more likely to be hospitalized for respiratory infections than are non Hispanic white children.

These health implications are dire, but much of this suffering is preventable. Health and policy experts know what steps we can take to protect the health of our children, and decrease the health burden shouldered by frontline communities. A major step to cut pollution and help our lungs and climate is for the Washington Legislature to implement a Clean Fuel Standard by passing HB 1091, currently moving in the Senate.

This policy would help Washington meet its goals for cutting climate pollution, address health care costs and promote healthier communities, support and incentivize more electric cars, trucks, and buses, and expand local economies with increased production of low-carbon, sustainable biofuels. And it’s working all around us: California, Oregon and British Columbia have had Clean Fuel Standards for years seeing less air pollution, cleaner vehicles, local clean-economy jobs and billions in savings from the health benefits. This is the third time our Legislature has considered this solution, and this year it’s time to make it happen. Our lungs cannot wait.

Critics of this policy and allies of the oil industry have successfully delayed its implementation for years. And every year we wait is another year of preventable asthma attacks and related respiratory complications, another year of worsening lung conditions for some in our most vulnerable communities, and further unsustainable pollution of our atmosphere.

We know what the solution is. We’ve followed the evidence. A Clean Fuel Standard is a tested and proven way to address the egregious health inequities and encourage the transition to more sustainable transportation options. This is the year the Washington Senate must act, and pass this policy. The health and wellbeing of our patients demands it.


(1) American Academy of Pediatrics Committee on Environmental Health, Ambient Air Pollution: Health hazards to children. Pediatrics. 2004; 114: 1699–1707. Statement was reaffirmed in 2010. Dietert RR, Etzel RA, Chen D, et al. Workshop to identify critical windows of exposure for children’s health: Immune and respiratory systems workgroup summary. Environ Health Perspect. 2000; 108 (supp 3): 483–490

(2) Galizia A, Kinney PL. Year-round residence in areas of high ozone: Association with respiratory health in a nationwide sample of nonsmoking young adults. Environ Health Perspect. 1999; 107: 675–679. Also see Peters JM, Avol E, Gauderman WJ, Linn WS, Navidi W, London SJ, Margolis H, Rappaport E, Vora H, Gong H, Thomas DC. A study of twelve southern California communities with differing levels and types of air pollution. II: Effects on pulmonary function. Am J Respir Crit Care Med. 1999; 159: 768–775.

(3) Laurent O, Hu J, Li L, et al. A statewide nested case-control study of preterm birth and air pollution by source and composition: California, 2001–2008. Environ Health Perspect. 2016. 124:1479–1486. doi: 10.1289/ehp.1510133. Also see Nach RM, Mao G, Zhang X, et al. Intrauterine inflammation and maternal exposure to ambient PM2.5 during preconception and specific periods of pregnancy: the Boston Birth Cohort. Environ Health Perspect. 2016. 124:1608–1615; Also see Li S, Guo Y, Williams G. Acute impact of hourly ambient air pollution on preterm birth. Environ Health Perspect. 2016. 124:1623–1629;

(4) Bruce Bekkar, Susan Pacheco, Rupa Basu et al. Association of air pollution and heat exposure with preterm birth, low birthweight, and stillbirth in the US: A systematic review. JAMA Netw Open. 2020;3(6):e208243.

(5) Mutius, Erika V., et al. “Prematurity as a risk factor fo asthma in preadolescent children.” Journal of Pediatrics, vol. 123, no. 2, 1993, pp. 223–229.

(6) Mikati, Ihab, et al. “Disparities in distribution of particulate matter emission sources by race and poverty status.” American Journal of Public Health, vol. 108, no. 4, 2018, pp. 480–485.

We are health care professionals, faith leaders, elected officials and community advocates supporting a Clean Fuel Standard for Washington State.